Protecting Patients by Immunizing Healthcare Workers

April 15, 2010

By Paul Etkind, MPH, DrPH, Senior Analyst on Immunization, NACCHO

The "Prime Directive" for medical care, to borrow a term from science fiction, is to do no harm. For that reason, industry professionals have been very conscious of and attentive to the issue of healthcare-associated infections (HAI). But one of the possible contributors to HAI that is not as often discussed is that of vaccination of medical care workers. A recent report from the Centers for Disease Control and Prevention (CDC) showed low rates of H1N1 flu vaccination among this group.

There are many other issues that can contribute to or cause HAI, including staffing levels that are often insufficient; excessive hours being worked creating a risk of error related to fatigue; product labeling that is often very similar and thus easily confused with one another; infection control protocols that are not followed; and paper medical records that increase the risk of not having all significant data included.

Medical care workers have earned the designation of being one of the hard-to-reach populations in regard to vaccinations, particularly in reference to flu vaccinations. Years of educational programming for healthcare professionals, the use of mobile vaccine clinics to hospital offices and floors, and various schemes using incentives for vaccination have resulted in only 40 percent (it has reached to just less than 50 percent one year) of medical care workers being routinely immunized against seasonal influenza.

The data are quite clear. Institutions with high rates of flu vaccinations among their medical providers have fewer absences among their staff and have fewer flu-like illnesses among their patients.

Mandating Flu Vaccines

Several organizations have moved towards regulating vaccination in the healthcare industry. In 2009, the National Influenza Vaccine Summit voted to support mandatory vaccination among hospital medical providers. The federal Advisory Committee on Immunization Practices, the American Public Health Association, the American Academy of Pediatrics, and various other professional organizations have or are in the process of endorsing mandatory flu vaccinations for medical care workers. The Immunization Action Coalition has a “hall of fame” on its website of medical care institutions that mandate flu vaccinations for its employees. At least one local health department has mandated flu vaccination for any employee involved in providing direct care to patients. New York state passed legislation to this effect, but the law was set aside in the 2009–2010 flu year because there was a shortage of vaccine, making it impossible to comply even if the medical care worker wanted to be immunized.

On April 2, the CDC issued its vaccination coverage estimates for the 2009–2010 seasonal and H1N1 flu vaccines, and it offered a mixed message. A record of 62 percent of medical care workers received seasonal flu vaccine, yet only 37 percent were vaccinated against H1N1. While the seasonal flu figure was good in a relative sense, it is still showing too much remaining room for improvement.

The H1N1 result shows there continues to be a serious problem among healthcare workers in taking their responsibility to their patients as seriously as they could and should. Anecdotal information continues to say that many healthcare workers don’t think that they need the vaccine. Other anecdotal information indicates a pervasive belief among healthcare workers that the H1N1 vaccine was somehow an experimental vaccine. There is no basis in the data for either belief. A recent analysis of the Vaccine Adverse Event Reporting System, a database of information on adverse effects of vaccination provided voluntarily by the public, found that the numbers of cases of Guillain-Barre syndrome related to the H1N1 vaccine were low.

For many people, physicians and other medical care providers are among the most respected and persuasive sources of information regarding medical advice. It is a serious problem to see that medical providers continue to believe in misinformation about their risks of contracting flu infections. In doing so, they raise those same risks for their patients. This is contrary to their professional and ethical responsibilities. A serious self-examination of these beliefs and actions is urgently in order.